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ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR, OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-6145
Telephone (516) 765-1800
Permit No. 2098 R
Residential
X
Non -Residential
Fee $ 10.00
Septic
X
Cesspool
PERMIT ISSUED TO:
Name : PETER KAYWOOD
Address 1: 33 NORTHRIDGE DRIVE
City St Zip CORAM NY 01172
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #1110-96-0061
Name Of Owner KAYWOOD, PETER
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Mailing Address 1 2222-C ROUTE 112
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City St Zip MEDFORD NY 11763
-------------------- -- ----------
Property Address 1 LAUREL AVENUE
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City St Zip LAUREL NY 11948
-------------------- ------------
Tax Map No. section 56.00 block 1 lot 2.026
Cross Street POND AVENUE
------------------------------
Building Permit Number Cross Reference:
Issue Date: 7/01/99
----------------------------------
Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.
TOWN CL]
REGISTRAR OF VITA
MARRIAGE 01
RECORDS MANAGEN
FREEDOM OF INFORM
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
16=
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-6145
Telephone (516) 765-1800
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 22, 1999
Transmitted herewith is a copy of application No. 2186 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peter Kaywood
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
gnature
Dated
'w
. OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
ELIZABET11 A NEVILLE, TOWN CLERK
P.O. BOX 1179
SOUTHOLD, NEW YORK 11971
Telephone
(516) 765-1801
Permit No.
Fee $
TOWN OF SOUTHOLD
Application No. �o
Construction ✓—
Alteration
$10.00 -Residential
$25.00 -Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICANT NAME:
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
❑►
DATE
v
APPLICANT ADDRESS: 33 Nor�hf;'IDb��r,1�e
Cow) NI' 1172
SEPTIC I CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: _fek(ea No01b
OWNER MAILING ADDRESS: .)d,9o1-C Povit I I a
fi��i�(d N �• f 17� 3
OWNER PROPERTY ADDRESS.: Si .Scrn P
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section 51,, Block I Lot 2.a to
CROSS STREET: '?0r)d 1)yenue
BUILDING PERMIT NUMBER CROSS REFERENCE:
1 1 SigS�ature of Applicant
RECEI'
DATE:
A'
i
R�
04-04-96'
ORAKN BY.
I .�A /E.
`CHECKED 81, JM
-
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200-96
SHEET or
ay No.
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TEST BORING DATA
FROM SUBDIVISION ANP OF LONG POND ES'ATES
SECTION 2 FILED NOV. 29. +990 F4.E NO. 9071
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UNAUTHORIZED ALTERATION OR ADCi TION
TOTHIS SURVEY IS A AOLATION OF
SECTION 7209 OF THE NEW YORK STATE
EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONS,DERED
TO BE A VALID TRUE COPY.
GUARANTEES INDICATED IE.REON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION. GUARANTEES ARE .NOT TRANSFERABLE.
THE EXISTENCE OF RIGHT OF WAYS
AND OR/EASEMENTS OF RECORD IF
ANY. NOT SHOWN ARE NOT
GUARANTEED.
THE WATER S --ply, WELLS ANO CESSPOOLS
SHOWN HERON ARE FROM FrELD OBSERVATIONS
AND OR DATA GB-A;NED FROM O -HERS
AREA= 40,422 S.F.
SUFFOLK COUNTY nBrARTM M f OF IWALTH SMVWM
PERbIIT VNGL6 FAAMII.T RZSIDRNQ ONLY
WVAL Or � t A
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WATER*WLY AND SEWAGE DMOSAL SYSTEMS MI1S? y ✓, �Y.
ap p repar a re d for: CONFORM WTM NEW STANDARDS DATED NOVEMBER 9!5. 13,1 \ �F �
Mp`� /
'tie water �.aa-r ^o se +.oqe o:saosa�
systems os !^, s eSCe^Ce CG^�C'^`.
to the sto^, ..^.airs 5� -wnp
'Depot r-�ent n ect� ~Sa•. -cesK
5'y^ec-----
1 J L4AT SURVEYING
TIT'.; .fr UCRTOA:;c »RVEYS
TOP :•:,wa CHIC i..;5
;ANE =-_ANNERS
SITE : ANS
TES' BORINGS
JOHN MINTO_L_S. ;5+6) 72a -x932
LICENSED PROFESSIONAL AND S'JRVE"OR
NEW YORK STATE LIG. NC .9886 :516) 361 - 7076
195 ALEXANDER AVENUE .NE. I;Cu % SET. N.Y. 11 767
SURVEY OF LOT 32
S, Q.
S -BD V SIO'1� MAP Ot �Cn.! -'OIvD ESTL 7c5
�7i'ED ',Ov. 29, 1990 N0. 903'
SITUATED AT
ARSHAMOMAQUE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
S.C.T.M. 10000-056-01-2.26
SCALE 1"= 40' MARCH 9, 1996
GRAPHIC SCALE
40 0 20 .0 60 160
( IN FEET )
1 inch = 40 ft.